Dental Management of the Medically Compromised Patient 8 Edition by Little – Test Bank
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Test
Little: Dental Management of the Medically Compromised Patient,
8th Edition
Chapter 03: Hypertension
Test Bank
MULTIPLE CHOICE
1. In prehypertension,
diastolic pressure ranges from ________ mm Hg.
|
A. |
80 to 89 |
|
B. |
90 to 99 |
|
C. |
100 to 109 |
|
D. |
110 to 119 |
ANS: A
The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
introduced the new category of prehypertension,
which encompasses the previously designated categories of normal and borderline hypertension.
Normal blood pressure is 120/80 mm Hg. Prehypertension is systolic blood
pressure ranging from 120 to 139 and diastolic pressure ranging from 80 to 89
mm Hg.
PTS:
1
REF: p. 38
2. Which
of the following types of health professionals can make the diagnosis of
hypertension and decide on its treatment?
|
A. |
physician |
|
B. |
dentist |
|
C. |
dental hygienist |
|
D. |
a, b, and c |
|
E. |
a and c only |
ANS: A
Only a physician can make the diagnosis of hypertension and
decide on its treatment. The dentist, however, should detect abnormal blood
pressure measurements, which then become the basis for referral to or
consultation with a physician.
PTS:
1
REF: p. 44
3. Which
of the following is the most common cardiac condition in America?
|
A. |
congestive heart failure |
|
B. |
cardiac arrhythmia |
|
C. |
hypertension |
|
D. |
angina |
ANS: C
With 35 million office visits annually, hypertension is the most
common primary diagnosis in America. According to National Health and Nutrition
Examination Survey (NHANES) data for the period 1999 to 2000, at least 65
million adults in the United States have high blood pressure (HBP) or are
taking antihypertensive medication. This estimate equals about one-fourth of
the population and represents a 30% increase from 1988 to 1994. In a typical
practice population of 2,000 patients, therefore, around 500 will have
hypertension.
PTS:
1
REF: p. 37
4. It is
estimated that about __% of all blood pressure–related deaths from coronary
heart disease occur in persons with blood pressure in the prehypertensive range.
|
A. |
less than 1 |
|
B. |
5 |
|
C. |
15 |
|
D. |
25 |
ANS: C
About 15%. However, the higher the blood pressure, the greater
the chances of heart attack, heart failure, stroke, and kidney disease. For
every increase in blood pressure of 20 mm Hg systolic and 10 mm Hg diastolic, a
doubling of mortality related to ischemic heart disease and stroke occurs.
PTS:
1
REF: p. 39
5. Which
of the following is most often the first drug category of choice if lifestyle
modification is ineffective at lowering blood pressure?
|
A. |
beta blockers (BBs) |
|
B. |
thiazide diuretics |
|
C. |
angiotensin-converting
enzyme inhibitors (ACEIs) |
|
D. |
angiotensin receptor
blockers (ARBs) |
ANS: B
Thiazide diuretics are most often the first drugs of choice,
given either alone or in combination with ACEIs, ARBs, BBs, or calcium channel
blockers (CCBs), depending on the degree of elevation of blood pressure. For
early stage 1 hypertension, single-drug therapy may be effective; however, for
later stage 1 and for stage 2 hypertension, two or more drug combinations are
necessary. The presence of certain comorbid conditions or factors, such as
heart failure, previous MI, diabetes, or kidney disease, may be a compelling
reason to select specific drugs or classes of drugs that have been found to be
beneficial in clinical trials.
PTS:
1
REF: p. 41
6. Deferral
of elective dental care and referral to a physician for evaluation and
treatment within 1 week are indicated for patients found to have asymptomatic
blood pressure of greater than or equal to ________ mm Hg.
|
A. |
160/90 |
|
B. |
160/110 |
|
C. |
180/90 |
|
D. |
180/110 |
ANS: D
Patients with blood pressures less than 180/110 mm Hg can
undergo any necessary dental treatment, both surgical and nonsurgical, with
very little risk of an adverse outcome. For patients found to have asymptomatic
blood pressure of 180/110 mm Hg or greater (uncontrolled hypertension),
elective dental care should be deferred, and physician referral for evaluation
and treatment within 1 week is indicated. Patients with uncontrolled blood
pressure associated with symptoms such as headache, shortness of breath, or
chest pain should be referred to a physician for immediate evaluation.
PTS:
1
REF: p. 46
7. Which
of the following is recommended for stress management for dental patients with
hypertension?
|
A. |
afternoon appointments |
|
B. |
premedication with a
barbiturate |
|
C. |
nitrous oxide plus oxygen
for inhalation sedation |
|
D. |
keeping the dental chair in
an upright position during treatment |
ANS: C
Nitrous oxide plus oxygen for inhalation sedation is an
excellent intraoperative anxiolytic for use in patients with hypertension. Care
is indicated to ensure adequate oxygenation at all times, avoiding
post-diffusion hypoxia at the termination of administration. Short morning
appointments seem best tolerated. Oral premedication with a short-acting
benzodiazepine can reduce anxiety for many patients. Because many of the
antihypertensive agents tend to produce orthostatic hypotension as a side
effect, rapid changes in chair position during dental treatment should be
avoided.
PTS:
1
REF: p. 46
8. Use of
how many cartridges of 2% lidocaine with 1:100,000 epinephrine at one time is
considered to have little clinical risk for dental treatment of a patient with
hypertension?
|
A. |
2 |
|
B. |
4 |
|
C. |
6 |
|
D. |
8 |
ANS: A
The existing evidence indicates that use of modest doses (one or
two cartridges of 2% lidocaine with 1:100,000 epinephrine) carries little
clinical risk in patients with hypertension, the benefits of its use far
outweighing any potential problems. Use of more than this amount at one time
may be tolerated well enough but with increasing risk for adverse hemodynamic
changes.
PTS:
1
REF: p. 48
9. Which
of the following is an adverse drug interaction that may occur if a dental
anesthetic containing a vasoconstrictor is administered to a patient being
treated for hypertension with a non-selective β-adrenergic blocking agent?
|
A. |
hypotension |
|
B. |
hypertension |
|
C. |
respiratory alkalosis |
|
D. |
respiratory acidosis |
ANS: B
The basis for concern with use of non-selective β-adrenergic
blocking agents (e.g., propranolol) is that the normal compensatory
vasodilation of skeletal muscle vasculature mediated by beta 2 receptors is
inhibited by these drugs, and injection of epinephrine, levonordefrin, or any
other pressor agent may result in uncompensated peripheral vasoconstriction
because of unopposed stimulation of alpha 1 receptors. This vasoconstrictive
effect could potentially cause a significant elevation in blood pressure and a
compensatory bradycardia.
PTS:
1
REF: p. 48
Little: Dental Management of the Medically Compromised Patient,
8th Edition
Chapter 04: Ischemic Heart Disease
Test Bank
MULTIPLE CHOICE
1. Which
of the following is true concerning the incidence and prevalence of ischemic
heart disease in the United States?
|
A. |
About 50% of the population
is estimated to have some form of cardiovascular disease. |
|
B. |
Cardiovascular disease
begins in middle life. |
|
C. |
The annual mortality rate
for cardiovascular diseases has been declining since 1940. |
|
D. |
Cancer has replaced
coronary heart disease as the leading cause of death in the United States
after age 65. |
ANS: C
The annual mortality rate has been declining since 1940. From
1970 to 2000, mortality from coronary heart disease decreased by 50%, and from
stroke, by 60%. Despite this decline, cardiovascular diseases continue to pose
the most serious threat to health in America, accounting for about 33% of all
deaths. More than 70 million Americans (about 25% of the population) are
estimated to have some form of cardiovascular disease, with about 13 million
having coronary heart disease. Coronary heart disease is the leading cause of
death in the United States after age 65. Autopsy studies in the United States
have shown that cardiovascular disease begins at an early age.
PTS:
1
REF: p. 51
2. Which
of the following is true of stable angina?
|
A. |
pain is predictably
reproducible, unchanging, and consistent |
|
B. |
nitroglycerin relieves pain |
|
C. |
management involves
behavioral modification and lifestyle intervention |
|
D. |
all of the above |
ANS: D
Stable angina is pain that is predictably reproducible,
unchanging, and consistent over time. Pain typically is precipitated by
physical effort such as walking or climbing stairs but also may occur with
eating or stress. Pain is relieved by cessation of the precipitating activity,
by rest, or with the use of nitroglycerin. Medical management of a patient with
stable angina includes identification and treatment of associated diseases that
can precipitate or worsen angina, reduction in risk factors for cardiovascular
disease, behavioral modifications and lifestyle interventions, pharmacologic
management, and revascularization by percutaneous catheter–based techniques or
by coronary artery bypass surgery
PTS:
1
REF: p. 54-55
3. Which
of the following is the single most important modifiable risk factor for
coronary heart disease?
|
A. |
diet high in cholesterol |
|
B. |
failure to exercise |
|
C. |
smoking cigarettes |
|
D. |
smoking cigars |
ANS: C
Cigarette smoking is the single most important modifiable risk
factor for coronary heart disease. Persons who smoke 20 or more cigarettes
daily have a two- to four-fold increase in coronary heart disease. Pipe and
cigar smoking apparently convey little risk for development of heart disease.
PTS:
1
REF: p. 52
4. Which
of the following types of blood cells engulf lipid molecules to become foam
cells?
|
A. |
red blood cells |
|
B. |
macrophages |
|
C. |
neutrophils |
|
D. |
basophils |
ANS: B
Atheroma formation is initiated by adherence of monocytes to an
area of injured or altered endothelium. The attached monocytes then migrate
into the intima of the vessel and become macrophages. Lipids derived from LDLs
also enter through the injured or dysfunctional endothelium, forming
extracellular deposits or small pools. Macrophages then engulf lipid molecules
to become foam cells, which are characteristic features of the fatty streak.
PTS:
1
REF: p. 53
5. Which
of the following is the most important symptom of coronary atherosclerotic
heart disease?
|
A. |
pitting edema |
|
B. |
dysphagia |
|
C. |
dyspnea |
|
D. |
chest pain |
ANS: D
Chest pain is the most important symptom of coronary
atherosclerotic heart disease. The pain may be brief, as in angina pectoris
resulting from temporary ischemia of the myocardium, or it may be prolonged, as
in unstable angina or acute MI. Ischemic myocardial pain results from an
imbalance between the oxygen supply and the oxygen demand of the muscle.
PTS:
1
REF: pp. 54
6. Which
of the following is true of unstable angina?
|
A. |
Pain is precipitated by
physical effort and is relieved by cessation of the precipitating activity. |
|
B. |
Pain is relieved by
nitroglycerin. |
|
C. |
Pain is not relieved by
nitroglycerin. |
|
D. |
a and b |
|
E. |
a and c |
ANS: C
Unstable angina is defined as new-onset pain, pain that is
increasing in frequency or intensity, pain that is precipitated by less effort
than before, or pain that occurs at rest. This pain is not readily relieved by
nitroglycerin. Stable angina is pain that is predictably reproducible,
unchanging, and consistent over time. Pain typically is precipitated by
physical effort, such as walking or climbing stairs, but also may occur with
eating or stress. Pain is relieved by cessation of the precipitating activity,
by rest, or with the use of nitroglycerin.
PTS:
1
REF: p. 55
7. Which
of the following is the most common cause of sudden cardiac death?
|
A. |
ventricular fibrillation |
|
B. |
myocardial infarction |
|
C. |
coronary atherosclerosis |
|
D. |
pulmonary embolism |
ANS: A
The most common cause of sudden cardiac death is ventricular
fibrillation, a form of abnormal electrical activity resulting from
interruption of the heart’s electrical conduction system.
PTS: 1
REF: p. 55
8. Which
of the following is a serum enzyme determination used to establish the
diagnosis of acute myocardial infarction (MI) and to determine the extent of
infarction?
|
A. |
stress thallium-201
perfusion scintigraphy |
|
B. |
3-hydroxy-3-methylglutaryl-coenzyme
A reductase (HMG-CoA) |
|
C. |
troponin I and troponin T |
|
D. |
streptokinase (SK) |
ANS: C
Serum markers of acute MI most commonly used in clinical
practice include troponin I, troponin T, and creatine kinase isoenzyme (CK-MB).
These enzymes are released only when cell death (infarction) or injury to the
myocyte occurs. For investigation of acute MI, troponin assays have largely
replaced creatine kinase (CK) and CK-MB determinations because these markers
are more specific in differentiating cardiac muscle damage from trauma to
skeletal muscle or other organs.
PTS:
1
REF: p. 56
9. Which
of the following is true for an MI with ST segment elevation (STEMI)?
|
A. |
It is due to partial blockage
of coronary blood flow. |
|
B. |
It is due to complete
blockage of coronary blood flow. |
|
C. |
Early fibrinolytic therapy
will improve the outcome for a patient with STEMI. |
|
D. |
a and c |
|
E. |
b and c |
ANS: E
An MI with ST segment elevation is due to complete blockage of
coronary blood flow and more profound ischemia involving a relatively large
area of myocardium. An MI without ST segment elevation (non-STEMI) is due to
partial blockage of coronary blood flow. Early fibrinolytic therapy improves
outcomes in STEMI but not in non-STEMI.
PTS:
1
REF: p. 60
10. Which
of the following is true when planning dental treatment for a patient with
stable angina or a past history of MI without ischemic symptoms?
|
A. |
Administration of nitrous
oxide should be avoided. |
|
B. |
NSAIDs should be avoided in
patients with established cardiovascular disease. |
|
C. |
Nitroglycerin should be
administered prophylactically. |
|
D. |
A pulse oximeter should be
used. |
ANS: B
NSAIDs should be avoided in patients with established
cardiovascular disease, especially for those whose cardiac history includes an
MI. In a recent study, the use of NSAIDs in patients with previous MI was shown
to increase the risk for a subsequent myocardial infarction, even after only 7
days of NSAID administration.
PTS:
1
REF: p. 63-64
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